EM Vivas · Team-based care and CRM
CRM leadership and closed-loop communication
Clinical viva on crisis resource management in the ED.
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Target exams
ACEMFRCEMABEM
Prompt
A resus bay has no named leader and a nurse is about to push an unconfirmed adrenaline dose. Define CRM pillars, demonstrate closed-loop communication, and state a graded-assertiveness script.
Interpretation
Reveal interpretationShowHide
CRM applies aviation-derived crisis resource management to medicine: clear leadership, role allocation, situation awareness, resource utilisation, and communication under stress. The team leader stands back to maintain the global picture. Closed-loop communication for drugs: order (drug, dose, route) → readback → confirmation of administration. Graded assertiveness escalates safety concerns across the authority gradient (probe → alert → challenge → emergency intervention). Structured handoff tools (ISBAR/I-PASS) reduce information loss and error.[1]
References1ShowHide
- [1]Starmer AJ, Spector ND, Srivastava R, et al. Changes in medical errors after implementation of a handoff program. N Engl J Med, 2014.PMID 25372088